Reimbursement Team Lead
Position Title: | Reimbursement Team Lead |
Department: | Reimbursement |
Reports To: | Head of Reimbursement |
Job Type: | Full Time |
Shift: | Monday - Friday 08:30 AM - 05:00 PM |
Exempt / Non-Exempt: | Non Exempt |
Purpose
The Reimbursement Team Lead is responsible for overseeing and managing the reimbursement processes and team members within an organization.
Responsibilities
- Effectively track and assist recording of the On Boarding forms for the signed providers
- Maintain Master OB Tracker
- Communicate any changes to providers, resend, edit and email necessary documents each quarter with changes
- Report and track Medicaid Fee Schedules by state for Extremity Care products
- Assist IVR team as needed on prior authorization follow up
- Research the “pending auth” cases to document if process was followed for reimbursement
- Assist in developing and writing process and procedure manuals for department
- Research and respond to unusual or complex reimbursement scenarios assisting in appeals processes and requirements
- Assist providers with understanding of EC billing guides and the claim process
- Assist with daily distributor emails and provider inquiries
- Experience with payer websites, electronic clearinghouses, Availity
- Special projects, as assigned
- Maintain a working knowledge of FDA 21 CFR 1271, FDA 21 CFR 820, AATB standards, ISO Standards, cGMP/CGTP, other relevant regulations/standards, and internal organizational policies and standard operating procedures.
- Manage direct reports.
- Provide constructive feedback and guidance to develop leadership in direct reports and department management.
- Establish and monitor objective annual goals for direct reports.
- Conduct performance reviews and establish performance improvement plans as needed.
- Recruit, interview, and select personnel for hire.
- Maintain acceptable attendance and punctuality for scheduled work hours and meetings. Ensure completion of assigned tasks and responsibilities within defined timeframes.
- Flexibility to work outside of normal business hours during weekdays or weekends with reasonable advance notice to support business/operational needs when necessary.
- Perform other duties as assigned.
Skills
- Ability to interpret medical benefits, EOBs, appeal letter responses from payers
- Must have attentive to detail, accuracy and must possess organizational skills
- Excellent communication and documentation skills required
- Ability to discuss claim issues with providers, medical staff, and sales personnel
- Solid understanding of Medicare LCDs and commercial medical policies
- Knowledge of CPT, HCPCS, and ICD10 coding and medical terminology
- Ability to work independently and in a team environment
- Excellent attention to detail and organization
- Excellent written and verbal communication
- Highest level of ethics and integrity
- Ability to lead and motivate the right behaviors
- Ability to multi-task and work in a fast-paced environment
- Strong technical writing
- Effective project management
- Proficiency in Microsoft Office
Qualifications/Requirements
- Bachelor’s degree in business or related field, from an accredited college or university required.
- At least 3 year(s) of experience in medical billing, reimbursement, revenue cycle management or related field required.
- Associate’s degree (or 60 credit hours) may be substituted to meet up to 2 years of experience requirements.
- Bachelor’s degree may be substituted to meet up to 4 years of experience requirements.
- Master’s degree may be substituted to meet up to 6 years of experience requirements.
- Clearance of favorable background investigation required.